Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography

Aldhoon, Bashar; Wichterle, Dan; Peichl, Petr; Čihák, Robert; Kautzner, Josef

doi:10.1093/europace/eus304

Cited by 98 publications

(101 citation statements)

References 23 publications

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“…However, the other group of authors identified lower body weight as the only independent predictor of complications, with a 0.8% increased risk for every 10 kg of body weight reduction, most likely due to a tendency of the underweight patients to be overdosed with anticoagulant drugs during the procedure. The distribution of complication rate among patients ≤80 kg, 81-90 kg, 91-100 kg and >100 kg was 4.8%, 3.5%, 2.5% and 2.0%, respectively [133].…”

Section: Agementioning

confidence: 89%

“…Some studies indicated that the additional ablation of complex AF substrate either with linear ablation or CFAE ablation increases procedure risk [50,53,133]. The long procedure time, prolonged catheter manipulation in the LA, a higher energy output and ablation within the coronary sinus in order to achieve transmural lesion, may all increase the risk of perforation and embolism [135].…”

Section: Agementioning

confidence: 99%

“…Cardiac tamponade is the most common life-threatening complication of catheter ablation of AF, with incidence of 1% to 6% [120,123,124,125,133,125]. Cardiac tamponade may occur due to an inaccurate transseptal puncture, mechanical perforation with catheter or excessive local RF ablation with tissue overheating and steam-popping in the presence of anticoagulation [3,123].…”

Section: Agementioning

confidence: 99%

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Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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Section: Agementioning

confidence: 89%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

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Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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“…Monitoring of LET, periprocedural imaging with computed tomography, MRI or intracardiac echocardiography, modulation of power and duration of radiofrequency energy during ablation and mechanical esophageal displacement have been suggested as possible ways to decrease injury to the esophagus. [29][30][31][32][33][34][35][36][37] However, their roles in preventing VN injury during RFA have not been systematically studied. Further studies are therefore necessary to identify methods to safely perform AF ablation without damaging the VN.…”

Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation Ablation on Gastric Motility

Lakkireddy

Reddy

Atkins

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Collateral damage to the vagal nerve and the upper gastrointestinal (UGI) system during atrial fibrillation ablation has not been systematically evaluated. Methods and Results-We performed a prospective, observational study assessing the effect of atrial fibrillation ablation on the function of the vagus nerve/UGI system. All patients underwent esophageal manometry, gastric emptying study, and sham-feeding test (corresponding to esophageal, gastric, and small intestinal function evaluation, respectively) before ablation (baseline) and subsequently at 24 hours, 90 days, and 180 days after the procedure. In addition, UGI symptom assessment using the patient assessment of upper gastrointestinal disorders-symptom severity index (PAGI-SYM) questionnaire was performed at baseline and during each of the subsequent evaluations. Of the 27 patients enrolled in the study, 9 (33%) patients had abnormal UGI function at baseline; defined as at least one of the 3 abnormal tests. At 24 hours after the radiofrequency catheter ablation, 20 (74%) patients had at least 1 new abnormality on the UGI function tests (P<0.001). New onset esophageal dysmotility, delayed gastric emptying time, and abnormal sham-feeding tests were observed in 13 (48%), 13 (48%), and 9 (33%) patients, respectively. Mean PAGI-SYM scores increased from 7.78±6.6 at baseline to 15.56±13.4 (P=0.002) at 24 hours. New onset abnormalities persisted in 9 (33%) patients at 3 months and normalized in all patients at 6 months. Conclusions-Atrial fibrillation ablation results in functional impairment of the UGI system, including the esophagus, stomach, and small intestine. This impairment is transient and is probably mediated by the injury to the components of the vagal nerve. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT01396356.

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“…Furthermore, in many laboratories, ICE is routinely used to assist transseptal puncture; therefore, no additional costs are present in such a situation. 15 An observational retrospective study has shown that some LAA morphologies, assessed by CT, may be associated with an increased risk of stroke in low-risk patients. 16 However, the association of specific LAA morphologies with an increase in the risk of thrombus development in the LAA has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

Intracardiac Echocardiography for Detection of Thrombus in the Left Atrial Appendage

Baran¹,

Stec

Pilichowska-Paszkiet

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Transesophageal echocardiography (TEE) is the gold standard for the exclusion of thrombi in the left atrial appendage (LAA) before ablation for atrial fibrillation. Intracardiac echocardiography (ICE) is used to assist atrial fibrillation ablation; however, it can also be used for LAA imaging. The aim of our study was to determine whether ICE could replace TEE and to identify the optimal ICE placement for LAA visualization. Methods and Results-Seventy-six consecutive patients (56 men; mean age, 55±9.6 years) scheduled for atrial fibrillation ablation underwent TEE before the procedure and LAA assessment by ICE. An 8F AcuNav probe was introduced into right atrium, pulmonary artery, and coronary sinus. LAA structure was analyzed by the echocardiographer and electrophysiologist who were blinded to the results of TEE. ICE probe was positioned in the right atrium in all patients, in the pulmonary artery in 64 of 74 (86%) patients, and in the coronary sinus in 49 of 74 (66%) patients. The LAA was properly visualized in 56 of 64 (87.5%) patients from the pulmonary artery versus 13 of 49 (26%) patients from the coronary sinus (P<0.001). From the right atrium, the whole LAA cavity could not be seen in any patient. In those patients in whom LAA was visualized properly by ICE, a perfect agreement between ICE and TEE was obtained (both techniques detected LAA thrombus in 2 patients and excluded LAA thrombus in the remaining patients). Conclusions-ICE

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Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography

Abstract: Atrial fibrillation ablation procedures guided by ICE in a high-volume centre are associated with low rate of serious complications. The composite risk score consisting of body weight, age, gender, and complexity of procedure predicted complications.

Cited by 98 publications

References 23 publications

Catheter Ablation of Lone Atrial Fibrillation

Catheter Ablation of Lone Atrial Fibrillation

Effect of Atrial Fibrillation Ablation on Gastric Motility

Intracardiac Echocardiography for Detection of Thrombus in the Left Atrial Appendage

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